Light therapy produces improvements in brain structure & function in hockey player with persistent post-concussion symptoms

A 23-year-old professional hockey player was the subject of this light therapy case study

In a case study, an 8-week treatment of home-use light therapy improved brain structure and function, as well as neuropsychological test scores in a 23-year-old professional hockey player with persistent symptoms due to multiple concussions. After the treatment period, improvements included "increased brain volumes, improved functional connectivity, increased cerebral perfusion, and improvements on neuropsychological test scores." The study, by Linda L. Chao et al., was published on 9/8/20 in Frontiers in Neurology.

Vielight Neuro Gamma

This case study related to light therapy for persistent post-concussion symptoms is notable because of the extensive brain scans before and after the treatment. The study participant used both the Vielight Neuro Alpha and the Vielight Neuro Gamma Devices, which are commercially available light therapy devices. "PBM devices used are considered non-regulated under 'General Wellness: Policy for Low Risk' published by the Food and Drug Administration in September 2019."

The professional hockey player who reported headaches, mild anxiety, difficulty concentrating, and inability to pay attention. These symptoms were presumably caused by a history of six "documented" concussions from hockey, although a physician had never diagnosed him for mTBI. He had previously tried "acupuncture, nutritional supplements, and hyperbaric oxygen treatments for his condition." During the study, he continued to train but did not compete in his sport.

Light therapy, technically referred to as photobiomodulation, is a growing field. Photobiomodulation uses "red to near-infrared light to stimulate, heal, and protect tissue that has been injured or is at risk of dying." Researchers are studying light therapy for concussion and traumatic brain injury, depression, Parkinson's Disease, and Alzheimer's. The largest clinical trial to date is studying whether photobiomodulation can reverse mild to moderate Alzheimer's symptoms.

Previous small studies of in-clinic photobiomodulation for persistent post-concussion symptoms (often referred to as chronic mild traumatic brain injury) have shown positive results. Two case studies in 2011 showed improved cognitive function after home-based light therapy. An open-protocol clinical trial in 2014 with 11 subjects showed "significant improvements in cognitive performance." A 2015 review of 10 patients given near-infra-red (NIR) laser therapy found improvements in symptoms. 

In 2019, two case studies of light therapy for pro football players with possible CTE, presented a professional conference, demonstrated significant improvements on fMRI scans and symptoms. Dr. Naeser at the Boston VA is currently recruiting for an in-home light therapy study. Finally, the VA Boston Healthcare system has a light therapy home treatment program for veterans.

A transcranial photobiomodulation device "exposes neural tissue to a low fluence of light" via self-contained headsets that deliver near-infrared (NIR) light through the skull and through one nostril. This case study used the Vielight Neuro Alpha, which emits light NIR pulsed at 10 HZ, and the Neuro Alpha, which emits light pulsed at 40 HZ. The devices are designed to beam light to the brain's default mode network (DMN), "a group of strongly interconnected brain regions."

This case study participant approached Vielight, Inc with particular concern about "improving his mental acuity." The CEO of Vielight, Lew Lim, collaborated with researchers at the University of California, San Francisco, and the San Francisco VA Health Care System, to implement the case study.

Initially, the study participant was given the Vielight Neuro Gamma because previous studies indicated that NIR light pulsed at 40 HZ improved cognition. His treatment regime was every-other-day for 20 minutes. However, after one week, the subject reported an increase in his headaches. For this reason, he was switched to the Vielight Neuro Alpha (10 HZ) on an every-other-day regime, and his headaches resolved within ten days. 

Vielight Neuro Alpha

At this point, Vielight advised him to alternate between the Neuro Alpha and the Neuro Gamma, maintaining his every-other-day treatment schedule. After three weeks, Vielight advised him to switch to using only the Vielight Neuro Alpha on the every-other-day schedule. 

"This decision [to switch to the Neuro Alpha for the remainder of the study] was based on a report that PBM treatments pulsed at 10 Hz produced the most beneficial effects in an animal model of TBI." Interestingly, the 2011 animal model study the study authors are referring to compared NIR light delivered at a continuous wavelength, 10 HZ, and 100 HZ, so there was no comparison to NIR delivered at 40 HZ for TBI. The authors note that one of the study's limitations was the "non-systematic changes in the PBM device and the combination of devices that the subject used."

Vielight Neuro Duo

As a note to our readers, the Vielight Neuro Duo has both an Alpha (10 HZ) and a Gamma (40 HZ) controller. This product typically would not be used in a study, as researchers want to control which type of wavelength the subject is using.

In terms of results, the MRI scans showed improved cerebral blood flow and lymphatic flow in the subject after the 8-week treatment, which is important because "Significant reductions in cerebral blood flow (CBF) and lymphatic flow" have been reported in studies of chronic TBI patients. A recent study also found that mTBI decreases lymphatic flow due to inflammation; we covered this in our newsletter in the diagnostic section.

The fMRI scans showed significant normalization in functional connectivity between regions of the brain after the treatment period. This is notable because research has found abnormal functional connectivity in mTBI patients, which "may reflect compensatory neural processes."

The MRI scans revealed increases in grey matter in several brain regions after the treatment period. However, the authors note that "Volumetric changes in a single subject after 8 weeks should be interpreted cautiously as they are within the range of observational error."

The subject also took neuropsychological tests before and after treatment, with post-treatment improvement in almost all test scores for verbal learning and memory, executive function, verbal fluency, attention, and processing speed.

With regard to his headaches, "After 8 weeks of PBM treatments, the subject experienced subtle improvements in his headaches (HIT-6 score decreased from 76 to 70)." At a 14-month follow-up, during which time he used the Vielight device, "albeit with less regularity," the subject's headache score was 50.

The limitations in the study include the use of more than one device and the possibility that improvement in neurological test scores may have, in part, been due to practice. However, the authors concluded that "These limitations notwithstanding, the present case report, along with other published studies, suggest that it is possible for individuals with histories of concussion or TBI to self-administer PBM therapy at home. "...this single, sports-related concussion case suggests that larger, controlled trials of PBM for TBI and additional research on the optimal PBM treatment parameters for TBI are warranted."

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